I am a family physician practicing in Toronto, Ontario. I will be implementing an Electronic Medical Record in my practice, starting in March 2006. This blog is a diary of what happened.

Monday, January 02, 2006

The decision to start an EMR: background information

I have wanted to computerize my records for a long time. However, like most of my colleagues, I have been reluctant to do so.

The major issues, as outlined in a recent Canadian Medical Association Journal have been cost, worries about long term reliability of the software companies, and lack of connectivity with other parts of our health care system. There is no question that EMRs are good for patients and good for the system. The rewards for physicians are less obvious.

Family medicine has been changing recently in Ontario. The government has been promoting "primary care renewal", and has been actively trying to change how we practice and how we are paid. One of the models is the "Family Health Network", in which you form a group with at least 5 of your colleagues, and agree to share call. The payment is a blended system; most of the funding is by capitation (a set amount of money per patient, depending on their age and sex), with some incentives (for example, for meeting targets for influenza vaccinations, patients age 65 and over), and a small amount of Fee for Service payment.

The FHN contract also includes help to implement EMRs (financial and support from a transition team). That was one of the main reasons for me to join a FHN. At the time we signed the contract (2003), my FHN did not know exactly what the support entailed; however, we knew that it was coming. This helped with financial concerns. We also knew that the government was in the process of certifying software companies.